Non-lethal strangulation has become more common in domestic abuse cases in the United States over the last decade, but its seriousness has been historically minimized by the legal, law enforcement and medical communities since most victims survive, experts say.

But strangulation is ranked as more dangerous than other forms of physical abuse, and studies suggest that strangulation is often a predictor for homicide. Repeated strangulation can lead to other serious health problems, abuse experts say.

A 2008 study in the Journal of Emergency Medicine suggested that the risks of an attempted homicide increase about sevenfold for women who have been strangled by their partner. The study also found that 43 percent of women murdered in domestic assaults, and 45 percent of victims of attempted murder, had been strangled by a partner in the previous year. “If someone was stabbed and survived, we’d say that was a very close call. If someone says she was strangled and survived we don’t say, you were lucky,” said Gael Strack, CEO of the National Family Justice Center in San Diego, Calif.

LIFE IN YOUR HANDS
At least five women were fatally strangled by intimate partners or spouses between 2007 and last year in Bucks and Montgomery counties, according to the Pennsylvania Coalition Against Domestic Violence. While most domestic violence murder victims are shot or stabbed, strangulation has moved up to the third-most frequent cause of death in Pennsylvania, reflecting about 10 percent of the 110 domestic-related murder victims last year.

Last year, nine people were fatally strangled in the state, and strangulation was listed as a contributing cause in two other deaths, according to the coalition’s annual report. Four of the 76 domestic violence-related victims were killed by strangulation in 2000.

Strangulation was the focus at a coalition education conference last year, legal director Ellen Kramer said. In recent years, the group has worked on raising awareness among law enforcement and legal communities about its dangers, Kramer said. Last year, the coalition worked with the Pennsylvania Chiefs of Police Association to develop an officer training program on strangulation.

Some local domestic abuse experts and law enforcement members say they are seeing strangulation more frequently in domestic incidents.
“This year specifically I have recognized within reports references to abusers’ ‘hands around neck,’ ” said Lower Makefield police Sgt. Gail Jones, who follows domestic abuse cases in the township.

Bucks County’s domestic violence prevention program, A Woman’s Place, doesn’t keep statistics on the types of abuse reported, but it has noted a “definite” increase in clients who report being strangled, said Linda Thomas, the agency’s director of institutional advocacy.
Many women have told Thomas that they saw stars or light before blacking out. She added that many people think once the strangulation stops and they can breathe again, they are not injured. As little as 10 seconds of pressure on the carotid arteries in the neck is enough to deprive the brain of oxygen and cause someone to lose consciousness. If the pressure continues, brain death can occur in as quickly as five minutes, said the National Family Justice Center’s Strack. But even if the pressure is released — and consciousness regained — the person may experience serious, potentially fatal, injuries. Swollen vocal cords can block breathing and lead to death hours or days later. Repeated incidents of strangulation can cause permanent artery and blood vessel damage that can result in an increased risk of early stroke. Blocking the jugular veins prevents de-oxygenated blood from exiting the brain, increasing the risk of brain damage, which can be cumulative.
“No one understands that,” she added.

SERIOUS CRIME
When Lois Fasnacht worked as a domestic abuse advocate, she recalled often hearing victims describe abusers as grabbing them around the throat and shoving them against the wall. “That is a form of strangulation but you don’t think of it that way,” said Fasnacht, who is now a domestic abuse training specialist for the Pennsylvania Coalition Against Domestic Violence. “A lot of other people think strangled means death. A lot of people say when you’re strangled, you’re dead.”
Among the challenges with prosecuting non-lethal strangulation has been that, unlike a black eye or broken nose, the injuries may not be obvious, Strack and others said. A 1995 study found that in half of the strangling cases, people have no immediate signs of external injury, and 35 percent of the time the injuries are too minor for police to photograph. Strangulation presents with more subtle immediate signs, such as redness or scratches around the neck or chest, bloodshot eyes, dizziness, vomiting or loss of consciousness. Hours or days later, bruises also can form around the neck. Without signs of external injury, proving felony assault is difficult for prosecutors. Proving attempted murder is also tough since prosecutors have to prove the defendant intended to kill — not scare or control — the victim, experts say. But police can build a strong case if they know to ask the right questions, such as did the abuser say anything during the strangulation, and the injury signs to look for in suspected victims, Fascnacht said. “Law enforcement and prosecutors are starting to realize that it is a very deadly action, very lethal — I have your life in my hands,” Fasnacht said. “Just because you see the word choking, doesn’t mean this isn’t dangerous.”

The National Family Justice Center Alliance received a $400,000 U.S. Justice Department grant to fund a strangulation training institute, and Strack has traveled the country helping lawmakers draft bills and leading seminars for police. As domestic violence programs have focused more efforts on education and training involving strangulation, police officers are doing a better job at identifying it and charging appropriately, Strack said. As many as 30 states in the last five years have, under certain conditions, made it a felony to intentionally impede someone’s breathing, following cases involving domestic-related murders in which, before being killed, the victim reported nonlethal strangulation incidents.
But Pennsylvania is among the roughly 20 states where nonlethal strangulation is not defined as a crime. It is generally considered an assault that could be graded as a misdemeanor or felony. The Pennsylvania Coalition Against Domestic Violence has pushed for an amendment to the state’s assault statue to break out strangulation as a separate offense, but the bill has not found a sponsor.

Among the nine recent alleged non-lethal strangulation cases in the Lower Bucks area, most suspects were charged with simple assault, and in some instances, recklessly endangering another person.
Three cases included a felony charge of aggravated assault, but earlier this month a district judge dismissed the charge against the boyfriend of the Lower Makefield woman who said she was strangled to the point of vomiting. The man was held for trial on all other charges including simple assault.
Elsewhere, though, over the last five years, prosecutors have increasingly treated domestic cases involving accusations of strangulation more seriously, said Scott Burns, executive director of the National District Attorneys Association in Virginia. When strangulation is involved, it often results in more serious charges against defendants than in the past, he added.
“When I was a DA 10 years ago if we had a boyfriend strangle a girlfriend, he would have been charged with domestic violence. Today I may charge him with aggravated assault or attempt to cause death or serious bodily injury,” Burns said. “I just think it is education and a new heightened concern for that criminal act. It’s like DUI 40 years ago.”